Wiki Need advice for pre-auricular cyst!

[AN2114]

The doctor said he excised a pre-auricular cyst from a superficial parotid approach with facial nerve monitoring. The code I have for that is 42415. Will I have a problem with insurance for billing 42415 with a pre-auricular cyst diagnosis? Here is the op report:

Procedure: Excision Left Pre-Auricular cyst via Left Superficial Left Parotid Approach w/ Facial Nerve Monitoring

Patient was brought to the operative suite and transferred to the OR table. Anesthesia team induced anesthesia and intubated the patient. Modified blair incision was marked. 1% lidocaine with 1:100,000 epinephrine was injected into the marked site. #15 scalpel used to make incision. Sub SMAS flap raised anteriorly. Tragal cartilage skelotonized. A defect in the cartilage noted superior to tragus. This was traced posteriorly deep to the auricular cartilage. A cyst with sebaceous discharge was encountered. It was removed in its entirety. No further lesion was noted. The wound was irrigated. Subcutaneous tissue was closed with 4-0 vicryl. Skin was closed with 5-0 fast. Care was returned to anesthesia team who reversed anesthesia and extubated the patient. Patient was taken to PACU in stable condition.

 

[jackjones62]

Good Morning, CPT 42415 would be inappropriate, that is a superficial parotidectomy. A simple excision code (1144x) would not be appropriate ether as it would not require general anesthesia, SMA approach and facial nerve monitoring, my suggestion is to look at CPT 21011 thru 21014 and utilize ICD10 Q18.1.

Hope this helps.

 

[AN2114]

Good Morning, CPT 42415 would be inappropriate, that is a superficial parotidectomy. A simple excision code (1144x) would not be appropriate ether as it would not require general anesthesia, SMA approach and facial nerve monitoring, my suggestion is to look at CPT 21011 thru 21014 and utilize ICD10 Q18.1.

Hope this helps.

Thank you!

 

[b.cobuzzi]

Actually, for a pre-auricular cyst, I am not sure I agree that it would not be coded as 42815. There is nothing in 42815 that makes it a superficial parotidectomy. 42815 is: Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx. The note provided says that the dissection went down to cartilage. Otherwise, for pre-auricular cysts, I code as 42810, Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues. But 42810 is confined to skin and subcu. The note says the surgeon went deeper than subcu.